| NPI | 1740386879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN 2951) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 8856) |
| 103TC0700X Psychologist, Clinical (Licence: MA 8856) | |
| 103TC0700X Psychologist, Clinical (Licence: TN 2951) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2013-12-03 |